Part B News Features
Question: I recently saw a Department of Justice settlement in North Carolina that seemed to be entirely based on a pattern of upcoding E/M. I didn’t know federal prosecutors did that! Is it com... More
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Medical groups posted some big numbers in their use of modifier 25 (Significant, separately identifiable E/M service), reporting over 65 million claims and clearing $5 billion in payments in 2021, the... More
Question: I recently saw a Department of Justice settlement in North Carolina that seemed to be entirely based on a pattern of upcoding E/M. I didn’t know federal prosecutors did that! Is it com... More
Recent changes mandated by Congress and CMS that boost the status of physician assistants (PA) — or physician associates, as some groups prefer — is another sign that the providers formerl... More
Medical groups posted some big numbers in their use of modifier 25 (Significant, separately identifiable E/M service), reporting over 65 million claims and clearing $5 billion in payments in 2021, the... More
Tools
DecisionHealth has revised its tool for office/other outpatient E/M visits (99202-99215) to include encounters performed in the inpatient or observation (99221-99223 and 99231-99236), emergency department (99281-99285), nursing facility (99304-99310) and home or residence (99341-99350) settings and consults (99242-99245 and 99252-99255).
Take a look at the new, revised and potentially misvalued services that CMS identified in the proposed 2023 Medicare physician fee schedule. The downloadable document (xls) provides current and projected work relative value units (RVU) for each service, allowing you to compare RVU changes between 2022 and 2023.
Benchmark of the Week
Medical groups posted some big numbers in their use of modifier 25 (Significant, separately identifiable E/M service), reporting over 65 million claims and clearing $5 billion in payments in 2021, the latest year of available data. While payments grew, the usage numbers remained down from pre-COVID highs just two years earlier.
Claims for psychological, neuropsychological and neurobehavioral status testing increased and denials fell after the AMA made major revisions to the code sets in 2019, according to analysis of Medicare Part B data.

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